[Jim M2]

I met with Dr. Coufal on Friday (2/7/14). The facets are severely degenerated and one facet has fragmented. There are other issues. He feels the best approach for pain reduction is to remove the L5S1 charite and fuse L5S1 with fixation on the back side, i.e. 360 deg fusion. There will be a vascular surgeon assisting. Dr. Coufal's scheduler will call me later this week so we can talk about dates.

Having a vascular surgeon assisting will somewhat mitigate the risk if one of the iliac arteries gets accidently cut but obviously it's still a risk. Another risk is associated with removal of the plates. I pointed out in the CT that there appears to be bone growth around the edge of the plate and this may make removal messy or impossible. Dr. Cougal said he will not attempt to remove the plate if it is beyond his strength to do so safely. If it takes too much of his strength it makes for an unstable situation with the risk of damaging the spinal cord or other body part. If he can't get one or both out they will stay in and he will continue to fixate L5S1 from behind.

That's it for now.